Systematic review and meta-analysis of test accuracy for the diagnosis of suspected pulmonary embolism

Parth Patel, Payal Patel, Meha Bhatt, Cody Braun, Housne Begum, Wojtek Wiercioch, Jamie Varghese, David Wooldridge, Hani Alturkmani, Merrill Thomas, Mariam Baig, Waled Bahaj, Rasha Khatib, Rohan Kehar, Rakesh Ponnapureddy, Anchal Sethi, Ahmad Mustafa, Wendy Lim, Grégoire Le Gal, Shannon M. BatesLinda B. Haramati, Jeffrey Kline, Eddy Lang, Marc Righini, Mohamad A. Kalot, Nedaa M. Husainat, Yazan Nayif Al Jabiri, Holger J. Schünemann, Reem A. Mustafa

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations

Abstract

Pulmonary embolism (PE) is a common, potentially life-threatening yet treatable condition. Prompt diagnosis and expeditious therapeutic intervention is of paramount importance for optimal patient management. Our objective was to systematically review the accuracy of D-dimer assay, compression ultrasonography (CUS), computed tomography pulmonary angiography (CTPA), and ventilation-perfusion (V/Q) scanning for the diagnosis of suspected first and recurrent PE. We searched Cochrane Central, MEDLINE, and EMBASE for eligible studies, reference lists of relevant reviews, registered trials, and relevant conference proceedings. 2 investigators screened and abstracted data. Risk of bias was assessed using Quality Assessment of Diagnostic Accuracy Studies-2 and certainty of evidence using the Grading of Recommendations Assessment, Development and Evaluation framework. We pooled estimates of sensitivity and specificity. The review included 61 studies. The pooled estimates for D-dimer sensitivity and specificity were 0.97 (95% confidence interval [CI], 0.96-0.98) and 0.41 (95% CI, 0.36-0.46) respectively, whereas CTPA sensitivity and specificity were 0.94 (95% CI, 0.89-0.97) and 0.98 (95% CI, 0.97-0.99), respectively, and CUS sensitivity and specificity were 0.49 (95% CI, 0.31-0.66) and 0.96 (95% CI, 0.95-0.98), respectively. Three variations of pooled estimates for sensitivity and specificity of V/Q scan were carried out, based on interpretation of test results. D-dimer had the highest sensitivity when compared with imaging. CTPA and V/Q scans (high probability scan as a positive and low/non-diagnostic/normal scan as negative) both had the highest specificity. This systematic review was registered on PROSPERO as CRD42018084669.

Original languageEnglish (US)
Pages (from-to)4296-4311
Number of pages16
JournalBlood Advances
Volume4
Issue number18
DOIs
StatePublished - Sep 2020

ASJC Scopus subject areas

  • Hematology

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